Sjögren’s Syndrome — Introduction

Ever since tennis champion Venus Williams dropped out of the U.S. Open tennis competition back in 2011, interest has trended upward for the incurable immune system disease that threatened to end her career.

Despite the diagnosis of Sjögren’s syndrome, which Venus has been battling for more than six years, she continues to play today like the champion she is. Media outlets from People Magazine and Essence to The Dr. Oz Show follow her progress and celebrate her success. Not long ago she won the Wimbledon women’s doubles championship with her sister Serena in July of 2016. Later that year she captured an Olympic mixed-doubles silver medal in Rio de Janero with partner Rajeev Ram. In January 2017 she battled all the way to the finals of the Australian Open. At the age of 37 in July 2017 she reached the Wimbledon singles final. Most recently in September 2017 Venus Williams became the oldest woman ever to reach the U. S. Open women’s semifinals. She shows few signs of slowing down now despite her Sjögren’s syndrome diagnosis.

With a condition as complex as Sjögren’s, there is an abundance of information circulating — some of it conflicting or not very well documented. Many questions still surround the diagnosis:

What is the real truth about Sjögren’s syndrome?

Do we know the cause(s)?

Are effective treatments available now?

What is the likely prognosis for an individual diagnosed with Sjögren’s today?

Which current research efforts are likely to improve the outcome?

Read on to learn more about challenges and opportunities confronting Venus Williams and the other 500,000 to 4 million Sjögren’s patients in the United States today.

Sjögren’s Syndrome — Definition and Epidemiology

Sjögren’s (SHOW-grins) syndrome is a chronic (persistent, long-lasting), systemic (affects the entire body), autoimmune disease that causes dryness of the eyes, mouth and other body parts. Along with those symptoms of extensive dryness, other serious complications include profound fatigue, chronic pain, major organ involvement, neuropathies and lymphomas.

By definition an autoimmune disease results from the abnormal production of extra antibodies in the blood. The immune system then mistakenly directs these antibodies to attack healthy tissue, which in turn leads to inflammation. Specifically with Sjögren’s syndrome the lymphocytes (infection-fighting cells of the immune system) attack normal cells of exocrine glands (glands whose secretions pass through a duct directly to the outside of the body) that produce moisture in the eyes, mouth and other tissues. This action can damage the glands to a point where eventually they are unable to produce adequate moisture.

Today the Sjögren’s Syndrome Foundation estimates that as many as four million Americans are living with this disease. It is the second most common autoimmune disease (after rheumatoid arthritis and ahead of lupus). Studies of the epidemiology of Sjögren’s syndrome report a prevalence of between 0.05 and 4.8 percent of the population. Prevalence rises with age. Ninety percent of people with the condition are female. Most individuals are 40 years or older when diagnosed; although, Sjögren’s can occur in all age groups, including children, and in both sexes and all races.

Although scientists do not know the exact cause of Sjögren’s syndrome, they think it may start with exposure of susceptible genes to a viral or bacterial antigen. There also seems to be familial predisposition associated with the condition. Chances of a person developing Sjögren’s syndrome are greater if close blood relatives have a history of it or of another autoimmune diseases.

Sjögren’s Syndrome — Classification

The disease is usually classified according to the following distinctions, which occur in almost equal numbers:

note: this classification system does not necessarily correlate with the severity of symptoms or complications. Primary Sjögren’s and Secondary Sjögren’s patients all are susceptible to the same level of discomfort, complications and seriousness of the disease.

Sjögren’s Syndrome — Prognosis

Most patients with Sjögren’s syndrome remain relatively healthy, but some rare complications, including an increased risk for cancer of the lymph glands, may develop. B-cell lymphoma is 24 times more common in Sjögren’s patients than in the general population. Regular medical care and follow-up is important for all Sjögren’s sufferers.

Sjögren’s syndrome is not curable, but in many cases proper treatment helps to alleviate or minimize symptoms. Often people with Sjögren’s are able to live relatively normal lives with only minor adjustments. Treatment needs to be individualized for each person and determined by which parts of the body are affected. Typically the program will focus on eliminating or managing symptoms as well as preventing and treating long-term complications.

note: treatments often do not completely eradicate the symptoms of dryness.

For more information about Sjögren’s syndrome, please read Vitamin Insider posts about “Symptoms/Cause(s)/Diagnostic Techniques” and “Current Treatments and Research for the Future.”

Can Viral Infection Cause Vertigo and Hearing Loss?

The relation of viral infection to subsequent hearing loss and vertigo symptoms is a subject of concern. Proper function of the inner ear is essential for both hearing and balance. Vestibular neuritis and labyrinthitis are the two major conditions that result from inflammation caused by infection of the inner ear. Both can have devastating effects. Such infections are usually of viral origin; less commonly the cause may be bacterial.

Vestibular neuritis and labyrinthitis are disorders thought to result from an infection that inflames the inner ear or the nerves connecting the inner ear to the brain. This inflammation disrupts normal transmission of sensory information from the ear to the brain. Vertigo, dizziness and difficulties with balance, vision or hearing may result.

In the inner ear both vestibular neuritis and and labyrinthitis affect one specific nerve, the vestibulocochlear nerve. This nerve sends balance and head position information from the inner ear to the brain. When swollen or inflamed, though, it disrupts the way the information would normally be interpreted by the brain.

Vestibular neuritis is a common cause of vertigo, labyrinthitis less so. Typically, though, they both produce disturbances of balance to varying degrees and may affect one or both ears.

Definition

Vestibular neuritis and labyrinthitis are closely-related disorders. Vestibular neuritis results from the swelling of one branch of the vestibulocochlear nerve (the vestibular portion) that affects balance. Labyrinthitis, in contrast, involves the swelling of both branches of the vestibulocochlear nerve (the vestibular portion and the cochlear portion) and impacts both balance and hearing.

Cause

Researchers think the most likely cause involves a viral infection of the inner ear, swelling around the vestibulocochlear nerve (usually caused by a virus) or a viral infection that has occurred somewhere else in the body. Some examples of viral infections in other areas of the body include herpes virus (causes cold sores, shingles, chickenpox), measles, flu, mumps, hepatitis and polio. Genital herpes, though, is not a cause of vestibular neuritis.

Even though the exact cause is not yet clear, evidence clearly shows that labyrinthitis and vestibular neuritis are likely to develop after a viral infection or, more rarely, after an infection caused by bacteria. Either condition seemingly can be triggered by an upper respiratory infection such as the flu or a cold. Less often, it may start after a middle ear infection. Other causes may include allergies or certain drugs that are risky for the inner ear.

When infection inflames the vestibular nerve, it sends incorrect messages to the brain signaling that the body is moving. The other senses –such as vision — do not detect the same movement however. The resulting confusion in signals can then make a sufferer feel as if the room is spinning or that he or she has lost balance (vertigo).

Risk factors:

Drinking large amounts of alcohol

Fatigue

History of allergies

Recent viral illness, respiratory infection or ear infection

Smoking

Stress

Using certain prescription or nonprescription drugs (e.g., aspirin)

Symptoms

Symptoms of viral neuritis can be mild or severe, ranging from subtle dizziness to the violent spinning/whirling sensation of vertigo. They can also include nausea, vomiting, unsteadiness and imbalance, difficulty with vision and impaired concentration. In some cases symptoms become so severe that they affect the ability to stand up or walk.

The symptoms of labyrinthitis are the same as those of vestibular neuritis often with the additional symptoms of tinnitus (ringing in the ears) and/or hearing loss.

Typically this type of vertigo begins without warning, its onset often commencing one to two weeks after a bout of the flu or a cold. The most severe symptoms generally last only a couple days but, while present, make it extremely difficult to perform even routine activities of daily living. After the worst symptoms lessen, most patients make a slow but full recovery over the next several weeks. For a month or longer, though, a sufferer may still get vertigo symptoms when moving the head in a certain way. In a few cases some patients may experience balance and dizziness problems that last for several months.

Epidemiology

Dizziness is the primary complaint in 3.3% of all U.S. hospital emergency department visits. Approximately 5.6% of these patients are eventually diagnosed with vestibular neuritis or labyrinthitis. The annual incidence of the two combined diagnoses in the United States computes to be approximately 150,000 patients.

Vestibular neuritis is the third most common cause of peripheral vestibular vertigo. It has an annual incidence of 3.5 per 100,000 population and accounts for 7% of the patients at outpatient clinics specializing in the treatment of vertigo. Vestibular neuritis can affect both adults and children but has a peak age of onset between 40 and 50 years.

Viral labyrinthitis is the most common form of labyrinthitis. It usually occurs in adults aged 30 to 60 years but rarely in children. It most frequently appears in the fourth decade of life with women patients outnumbering men by about 2:1. Bacterial labyrinthitis is rare now in the post-antibiotic era.

There is wide variability in reported prevalence worldwide for diseases causing vestibular dysfunction — from 3.1% one-year prevalence to 35.4%. In all studies, though, occurrence was found to increase with age of the patient.

Diagnosis

Inner ear infections that cause vestibular neuritis or labyrinthitis are usually viral rather than bacterial. The symptoms of bacterial and viral infections may be similar. Treatments, on the other hand, are very different; therefore, initial diagnosis by a qualified physician is essential.

No specific tests are yet able to diagnose vestibular neuritis or labyrinthitis. As a consequence the process of elimination is often necessary for a default diagnosis. Because the symptoms of an inner ear virus often mimic other medical problems, a thorough examination is necessary to rule out other causes of dizziness (stroke, head injury, cardiovascular disease, allergies, side effects of prescription or nonprescription drugs [including alcohol, tobacco, caffeine and many illegal drugs], neurological disorders and anxiety).

A physician will usually begin the diagnostic process by doing a physical exam and asking about symptoms and health history. If the cause of vertigo is still not clear, the doctor may order tests to rule out other causes of the symptoms. Such procedures are likely to include:

EEG

Videonystagmography or electronystagmography (caloric stimulation – warming and cooling the inner ear with air or water to test eye reflexes)

Head CT scan

Hearing tests (audiology/audiometry)

MRI of the head

Treatment

Medications can usually help manage symptoms. Vestibular rehabilitation therapy, though, may be necessary in some cases.

When other illnesses have been ruled out and the diagnosis of either vestibular neuritis or labyrinthitis established, then medications can generally control the worst of symptoms. Drugs are often prescribed to relieve nausea and to suppress dizziness during the acute phase. Antiemetics, antihistamines and sedatives may all be helpful as well. If nausea has been severe enough to cause excessive dehydration, intravenous fluids also may be necessary to re-establish fluid and electrolyte balance.

Usually symptoms will improve on their own. Resolution typically takes several weeks. If the cause is a bacterial infection, the doctor almost certainly will prescribe antibiotics. Most cases, though, are caused by viral infections, which cannot be cured with antibiotics.

Vertigo usually gets better over time as the body adjusts to a new reality (compensation). In some cases the doctor may eventually prescribe steroid medicines to decrease inflamation in the vestibular system. Pharmaceuticals like antihistamines, too, can sometimes help to relieve symptoms, but they may also extend the time needed for the vertigo to resolve. In general it is probably best to use medicines only when they are needed and for as little time as possible.

Finally staying active can help to speed recovery. Specific vestibular rehabilitation therapy may be useful in some cases. Check with your doctor for a physical therapy referral or for information about balance exercises to try at home. The regimen usually includes simple head movements and practice at maintaining balance while standing and sitting. With repetition such maneuvers may reduce symptoms of vertigo.

Prognosis

In most patients (95% and greater) vestibular neuritis or labyrinthitis is a one-time experience. Sufferers generally recover fully within a few weeks with or without symptomatic treatment. Improvement happens because of a combination of the body fighting off the infection and the brain accommodating to the vestibular imbalance (compensation). A minority, though, may experience vertiginous episodes following rapid head movement for months or even years after onset. Anxiety disorders and depression occur more often, too, with self-reported vestibular vertigo, as does cognitive impairment.

Because a virus usually causes inner ear infection, the microbe can run its course and then go dormant in the nerve only to flare up again at some time in the future. There is currently no way to predict whether it will recur.

If treated promptly, many inner ear infections cause no lasting damage. In some cases, however, permanent loss of hearing can result, ranging from barely detectable to total. Permanent damage to the vestibular system can also occur. Positional dizziness or BPPV (Benign Paroxysmal Positional Vertigo) can later present as a secondary type of dizziness that develops from neuritis or labyrinthitis and may recur chronically on its own. Labyrinthitis may also cause endolymphatic hydrops (abnormal fluctuations in the endolymph) to develop several years later.

Disequilibrium or positional vertigo may be present for the long term following resolution of an acute infection. If symptoms have not resolved completely within two to three months, though, further testing (e.g., an ENG, an audiogram or others) may be necessary to confirm the original diagnosis.

Hearing loss associated with viral labyrinthitis may eventually reverse. Suppurative labyrinthitis, though, usually leaves permanent and profound hearing loss. With labyrinthitis the recovery of hearing loss is more variable.

Sjögren’s Syndrome — Symptoms

Dry eyes and mouth (also known as “sicca syndrome”) are the most common signs of Sjögren’s syndrome. The disease, though, may affect other parts of the body as well. Symptoms typically cluster in the following categories:

Mouth

Thick or stringy saliva

Swollen salivary glands (located under the tongue, in the cheeks and along the jaw – especially the set located behind the jaw and in front of the ears)

Increased dental decay

Mouth sores or pain; dry or peeling lips

Loss of or change in sense of taste (dysgeusia)

Yeast infection in the mouth (thrush)

Eyes

Itching, dryness, burning and redness

Blurry vision

Feeling of grittiness (as if something like sand is in the eye)

Sensitivity to light

Nose, Throat and Airways

Impaired speaking or feeling of mouth “stuffed with cotton”

Persistent dry cough or hoarseness

Dryness in nose

Impairment or loss of sense of smell (parosmia/hyposmia/anosmia)

Difficulty swallowing or eating dry foods

Genital Area

Vaginal dryness

Sjögren’s syndrome can also cause swollen or painful joints, muscle pain or weakness, fatigue, dry skin, skin rashes and brain fog (poor concentration or memory). Numbness and tingling sensations in the arms and legs (paresthesia) probably correspond to progressive nerve involvement. Heartburn and inflammatory problems with kidney/lungs/liver and swollen lymph nodes are common. The parotid gland at the edge of the jaw may become swollen and inflamed in some Sjögren’s sufferers. Other patients may develop anemia and/or low white blood cell or platelet count.

Sjögren’s symptoms can vary widely from person to person and tend to worsen with stress. The disorder is highly unpredictable. There is no cure yet for this autoimmune disease. In some cases, though, it may go into remission for weeks, months or even years.

Sjögren’s Syndrome — Cause(s)

The exact cause of Sjögren’s syndrome has not yet been established. A person who develops the condition probably inherits the genetic risk from one or both parents. Then subsequently the actual condition develops after exposure to some type of environmental trigger. While there are certain genes that increase a person’s risk for Sjögren’s syndrome, those genes apparently do not act alone. It is believed that in order for a person actually to develop Sjögren’s, the immune system must first be hyperactivated by some substance from the environment – such as a viral or bacterial infection – that sends the immune system into overdrive.

Genome sequencing of Sjögren’s syndrome patients in both the U. S. and Asia has added greatly to understanding associated genetic factors. Scientists have identified at least five different risk-related major gene regions. Researchers are also evaluating the role of endocrine and nervous systems in development of the condition.

Evidence suggests that if a person’s close blood relative has Sjögren’s syndrome, then the individual is probably at significantly higher risk for it. In fact about 12 percent of Sjögren’s sufferers have one or more of their blood kin already suffering from the disease. It is also common for relatives of people with Sjögren’s syndrome to develop other types of autoimmune disease such as lupus or hypothyroidism.

While there is not yet a concrete answer as to why Sjögren’s syndrome affects women more often than men, researchers believe the hormone estrogen might play a role. One of the major risk factors associated with Sjögren’s syndrome is being a post-menopausal woman. Since it is well documented that estrogen levels in the female body fluctuate during and after menopause, researchers are investigating the possibility of a connection.

Sjögren’s Syndrome — Diagnosis

Sjögren’s syndrome can be difficult to identify and, for that reason, often goes undiagnosed or initially misdiagnosed. Because the symptoms of Sjögren’s syndrome develop gradually and are somewhat nonspecific (similar to those of many other diseases), reaching the correct diagnosis is likely to take extra time. This delay happens so often, in fact, that the Sjögren’s Syndrome Foundation reports an average of six and a half years from the time symptoms first appear until the diagnosis is finally extablished.

Once inside the healthcare system, a Sjögren’s sufferer potentially could see a number of different medical specialists, any one of whom might diagnose the disease and/or be involved in its treatment. These medical professionals are likely to include: rheumatologist (a doctor who specializes in diseases of the joints, muscles and bones as well as diagnosing and managing autoimmune disorders), primary care physician, internist, ophthalmologist (eye specialist), otolaryngologist (ear, nose and throat specialist) and/or other specialists. In the long term, though, it is usually the rheumatologist who will coordinate treatment involving a number of contributing specialists.

The symptoms of Sjögren’s syndrome can be confusing since they are often similar to those seen in women during normal menopause. They can be mistaken, too, for symptoms resulting from certain drug side effects or allergies. Other autoimmune diseases, such as lupus and rheumatoid arthritis, also may cause a similar presentation. The diagnosis can be even more challenging because, with this condition, symptoms do not always occur all at the same time. Since Sjögren’s can involve more than one body system, physicians or dentists may fail to realize that a systemic disease is actually at the root of the various clusters of problems.

Sjögren’s Syndrome — What Happens at the Doctor’s Office?

Early diagnosis is important in order to limit the cumulative effect of Sjögren’s on the eyes, mouth and other organs over time. The first doctor’s office visit typically will include a medical history and discussion of symptoms along with a physical examination. The healthcare team will be looking for changes in the eyes, mouth and salivary glands as well as muscle weakness, swelling of lymph nodes in the neck and joint inflammation. The initial physician is also likely to recommend a specialized eye examination to be done by an ophthalmologist. In addition a dental exam, done by a qualified dental specialist, may be necessary.

By definition Sjögren’s syndrome diagnosis requires that the person exhibit symptoms for a prolonged time (e.g., dry mouth for longer than three months) supported by positive laboratory test results. There is no single medical test for Sjögren’s syndrome. Several tests, considered together, will help a doctor establish the diagnosis. Such evaluation procedures typically include the following measures:

Blood tests

A number of diagnostic blood tests are necessary to establish the diagnosis of Sjögren’s syndrome. Among the most important are tests for the presence of certain antibodies that are markers for autoimmune disorders. These evaluations include the anti-nuclear antibody (ANA: present in about 70 percent of Sjögren’s patients) and the Sjögren’s-associated SS-A (also called anti-Ro: 70 percent of Sjögren’s patients are positive) and SS-B (also called anti-La: 40 percent are positive) antibodies. Rheumatoid factor (RF: 60 to 70 percent of Sjögren’s patients test positive) may also be present. Other blood tests can reveal more signs of inflammation. Markers include increased levels of immunoglobulin or C-reactive proteins (CRP). Both of these are proteins that signal immune reactions. An erythrocyte sedimentation rate (ESR or sed rate) test may also be necessary to disclose more general signs of increased inflammation.

Many experts also suggest to have blood tested (anti-transglutaminase IgG and IgA levels) for a genetic wheat allergy. This test is important because wheat allergy is positive in 14.7 percent of those with Sjögren’s vs. only 1 percent of the general population.

Dry eye tests

Eye tests can determine whether tear production is normal. They will also reveal areas of damage to the eye as a result of dryness. An ophthalmologist or a rheumatologist may perform the following tests:

Schirmer test – The Schirmer test determines how well an eye produces tears. An ophthalmologist gently inserts a small piece of sterile filter paper between the eye and eyelid in the inner corner of the eye. After several minutes the doctor measures the amount of wetness on the paper. A decreased amount of wetting is characteristic of Sjögren’s syndrome; however, decreased tear production can also occur with other conditions.

Lissamine green test – The dry eye of Sjögren’s syndrome can result in damage to the membranes surrounding the eye and eyelids. A test called the Lissamine green test detects scratches on the surface of the eye. A slit-lamp test checks the surface of the eye (cornea) for dryness-related damage.

Salivary gland tests.

A salivary gland biopsy requires removal of a small piece of tissue from the inner portion of the lip. Salivary gland flow rates may be further tested by several different methods. The most common of these evaluations is measurement of the volume of expectoration of saliva into a volumetric cup. Nuclear medicine methods that quantify the uptake and excretion of a specific substance (technetium) are more accurate but more expensive. New methods using ultrasound appear promising and may someday provide a noninvasive method to evaluate clinical status more accurately.

Chest X-ray

Corydalis — Is It the “Best-Ever” Pain Reliever?

With concern about pain relief at an all-time high, the herbal supplement known as corydalis is under close scrutiny. Journal articles, magazine features and television programs all tout the potential benefits of corydalis. Sufferers of both acute and chronic pain are looking for an effective approach to feel better fast. North America has possibly the worst opioid crisis anywhere in the modern world with more than 40 deaths daily from overdose. Could corydalis be the answer to prayer here?

Many experts believe that corydalis is effective to treat chronic, low-intensity, persistent pain. They appreciate, too, that it does not carry the risk of addiction that many pharmaceutical opiate drugs do. On a recent television broadcast of The Dr. Oz Show, for example, Dr. Mehmet Oz recommended corydalis. He suggested using it for relief of headaches, menstrual pain and backaches — even back pain caused by nerve problems and muscle spasms.

History of Corydalis Use

Corydalis has been in use since the eighth century A. D. as a blood vitalizer in Traditional Chinese Medicine (TCM) compounds. The herb is native to the Chinese province of Zhejiang. It now grows abundantly from the temperate Northern Hemisphere to the high mountains of tropical eastern Africa. It is also known as Chinese corydalis, yellow poppy or Yan Hu Suo (corydalis yanhusuo) in China, Engosaku in Japan and Yonhosaek in Korea.

In the Far East corydalis is thought to invigorate the blood, to move qi (energy that travels through the body) and to ease pain. It is classified as a powerful blood-moving herb, which relieves the stasis that causes pain according to TCM theory. Traditional practitioners often recommend it for relief of menstrual, abdominal and hernia discomfort. They also praise it for its mild analgesic, tranquilizing properties which relieve pain in general.

Corydalis: Its Current Use in TCM

This Chinese poppy plant, though non-addictive, exerts a powerful effect that can last as long as two hours. Many herbalists consider corydalis to be the second most effective pain reliever right behind opium. According to Chinese research, corydalis has an analgesic effect approximately 1% that of the strength of opium. Corydalis, though, does not have opium’s brutal side effects nor its potential for addiction. Corydalis appears as a potent ingredient in almost every TCM formula intended to manage pain. It is used, for example, to treat discomfort from the following condition:

menstrual cramps

abdominal/stomach ache

chest pain

hernia soreness

discomfort from traumatic injuries

Typically corydalis is blended with other botanicals to enhance specific treatments. This approach is known as the synergistic effect. Its efficacy is well documented both in TCM and through current scientific studies using modern pharmacology methods. For example, corydalis can be combined with herbs such as frankincense and myrrh to relieve pain from injuries. Cinnamon bark is routinely added to treat menstrual pain. Fennel is incorporated to manage the discomfort of hernia. Herbalists also recommend the combination of liguisticum with corydalis for headache. In addition the ancient tradition of frying the whole herb in vinegar may enhance its pain-relieving properties in general.

Some traditional medicine websites claim that corydalis can also be successful in treating other conditions such as:

mild depression

emotional disturbances and mild mental disorders

severe nerve damage

limb tremors

high blood pressure

spasms in the small intestine

Further research is needed, though, before making final conclusions about the effectiveness of the herb for each of the conditions listed above.

What Does Western Research Reveal about Corydalis?

According to researchers who recently published in Current Biology: “We have good medications for acute pain: codeine or morphine, for example. We have pain medication for inflammatory pain such as aspirin or acetaminophen. We do not have good medications for chronic pain.”

Those authors studied dehydrocorybulbine (DHCB), a compound isolated from roots of the corydalis plant. They found DHCB to have a positive effect on all three types of human pain — acute, inflammatory and chronic/neuropathic pain. Even better, it did not cause dependence, tolerance or side effects among laboratory test animals. They speculate that DHCB acts not through the morphine receptor but through other receptors that, instead, bind dopamine and block the pain signal pathway.

Traditional practitioners have successfully used corydalis in China since ancient times. Much of modern research done according to protocols of Western medicine, though, is still in early stages. Laboratory animal studies suggest that corydalis may work to treat pain triggered by cold. Research also shows it to be effective in blocking inflammation and nerve pain. Corydalis appears to work in a way like that of prescription drugs that block pain signals in the brain. When used long term, corydalis does not appear to lose its effectiveness. Neither does it lead to antinociceptive tolerance, where the patient needs ever-increasing dosages to get the same effect.

According to Chinese research, the root of corydalis plant is a source of more than 20 different alkaloids. In laboratory research these compounds exhibit pharmacological actions on the central nervous system. Pain relief and sedation are among the most prominent. Besides DHCB, its tetrahydropalmatine (THP) component is another alkaloid with analgesic activity. Corydalis also contains bulbocapnine, occasionally used to treat convulsions, Parkinson’s disease and Meniere’s disease. It has been used experimentally, too, in the treatment of muscular tremors and vestibular nystagmus.

How Much/What Kind of Corydalis Should I Take?

Corydalis can be purchased online, at health food stores or from some TCM practitioners such as acupuncturists and herbalists. It is available in several forms: whole herbs, granules or capsules and softgels. Liquid extracts of corydalis root are also available in some markets.

You will need boil the whole herb to prepare a drink, a tincture or a decoction. You can also prepare potent tinctures by immersing the whole herb in vodka (or other alcoholic beverage) for two weeks. In granular form it is a single herb that can be mixed with hot water as a tea and sipped throughout the day. The beverage, though, is somewhat bitter and acrid; so, the granules can, instead, be mixed into yogurt or applesauce. As a capsule, corydalis is sometimes blended with a second herb, angelica. Capsules, too, may need a little longer to take effect. You might have to combine multiple capsules to equal one dose; so, check the bottle label carefully. For liquid extracts, follow label or package insert instructions.

The appropriate dose of corydalis depends on multiple factors including the user’s age, health and other conditions. There is only scanty scientific information to establish a precise range of doses for corydalis. Some experts recommend taking three to nine grams total per day, broken up into two or three doses. Be sure to follow relevant directions on each product label. Always consult with your pharmacist, physician or other healthcare professional before using any new herbal product.

Precautions

Corydalis is generally considered to be safe for healthy adults. Experts recommend, though, to use it only for significant pain and not just to relieve occasional, minor discomfort. It should not be used at all by pregnant or breastfeeding women. The herb could possibly bring on vaginal bleeding and even cause the uterus to contract, eventually resulting in miscarriage. Not enough is known about the safety of using corydalis while breast-feeding; so, it is probably best to avoid use until breast feeding ends. People with an irregular heart rhythm or severe liver or kidney disease should not use corydalis without specific advice from a healthcare professional. Always keep it out of the reach of children.

Corydalis may have some interactions with certain medications. Use it with caution if you are also taking hypnotics, sedatives, cancer medications or anti-arrhythmic drugs. Corydalis may enhance the effects of sedatives, including alcohol and benzodiazepines. It also contains substances that reduce the formation of blood clots. People taking anticoagulant drugs, therefore, should use corydalis only under physician’s advice. In fact it is wise always to talk to a doctor or pharmacist about potential risks and benefits before trying any new herbal remedy or supplement. Overuse (many times the recommended dosage) could possibly lead to corydalis toxicity. In excess, it has potential to cause liver injury, nausea, fatigue or vertigo in some people.

Many herbal corydalis supplement products on the market today consist of ground herbs or corydalis granules. The highest quality product, though, results from a hot-water extraction process. This procedure assures technical purity as well as high potency of the concentrated, active ingredients. State-of-the-art extraction by hot water also safeguards against contamination by harmful chemicals or pollutants. Be sure to read the label carefully.

Suggestion

Before you begin taking corydalis, survey the range of other pain-relief treatments available on the market today:

Over-the-Counter Oral Analgesics

Topical Pain Relievers

Hot- and Cold-Packs

Natural (Alternative/Complimentary) Pain Remedies

You probably should also consult with your healthcare team for recommendations about the best pain reliever protocol for your specific needs.

What Is the Truth Behind Trending Interest in Benefits of Black Seed Oil?

Also known as nigella, black caraway, kalonji, Roman coriander, black onion seed, nutmeg flower, black cumin and fennel flower, this herb has a long history of use for medicinal, cosmetic and culinary purposes. Archaeologists even discovered black seeds preserved inside King Tut’s tomb. These seeds probably date back to 1323 B. C.

Among ancient Egyptians, Cleopatra is said to have used black seed oil for beautiful hair and skin. Hippocrates prescribed it for digestive troubles. The Old Testament of the Bible mentions black seed oil (Isiah 28:25-27 ). As long ago as 1025 A. D., Avicenna, in his Canon of Medicine, recommended it to treat dyspnea. The fourteenth century text, Medicines of the Prophet, lists as many as fifty different illnesses for which black seed preparations may have healing qualities.

Recently, though, there has been a flood of new information in scholarly journals and in the popular press about potential benefits of black seed oil. Since 1959 more than 200 studies were conducted and articles published internationally in various journals.

Given the scientific name Nigella sativa, this small flowering shrub is a member of the buttercup family. It grows with purple or white-tinged flowers and flourishes in Eastern Europe, the Middle East and western Asia. It produces fruits with tiny, crescent-shaped black seeds. The seeds have a pungent, bitter taste and odor sometimes described as a combination of onions, black pepper and oregano.

Black seed oil is available for purchase at most health food stores and pharmacies, usually sold as capsules for ease of consumption. It is available, too, as a liquid oil to apply topically to the skin and hair or to take by mouth from a spoon. While there are no well-established recommendations for intake, individual packaging will generally suggest a daily intake of about one to two teaspoons.

Health Benefits

Preliminary studies are now underway to investigate claims from traditional medicine that N. sativa has therapeutic efficacy. The seed oil extract or its volatile oil and the isolated constituent thymoquinone are principal forms of black seed under study.

Black seed oil displays strong antioxidant properties. It may help to reduce inflammation inside the body and on the skin. According to Egyptian Journal of Biochemistry & Molecular Biology it also shows antimicrobial activity against Candida albicans, a type of yeast that can overgrow in the body and lead to the condition known as candidiasis. There is some scientific evidence to suggest that black seed can also act as an antihistamine, but there isn’t yet sufficient data from human studies to confirm it.

Effects under Study

The following claims are currently under study:

Reducing high blood pressure:Taking black cumin seed extract for two months apparently can reduce hypertension in some people with mildly elevated blood pressure. One meta-analysis of clinical trials found a short-term benefit for it to lower both systolic and diastolic blood pressure.

Reducing high cholesterol:Another meta-analysis found that various extracts of black seed can reduce triglycerides, LDL (bad) and total cholesterol while raising HDL (good) cholesterol. It is high in healthy essential fatty acids such as linoleic and oleic. The levels of oil content can vary, though, depending on where the black seeds grow. Consuming the crushed seeds may also have a beneficial effect.

Liver health: In a recent Egyptian study scientists discovered that black seed oil benefits liver function. It may also help to prevent both liver damage and disease among laboratory rats.

Diabetes management: in the Journal of Endocrinology and Metabolism, researchers from the Indian Council of Medical Research report animal studies showing that black seed oil “causes gradual partial regeneration of pancreatic beta-cells, increases the lowered serum insulin concentrations and decreases the elevated serum glucose.” The effect has not yet been replicated in human studies.

What Role Might Black Seed Oil Have in Fighting Cancer?

Black seed oil may help fight against some skin cancers when applied topically. Research recently published in Biochemical Pharmacology investigates the effect of thymoquinone from black seed oil. Findings there document the reduction in growth of tumors in laboratory rats. Scientists in Croatia also discovered two phytochemicals in black seed oil that resulted in 52% decrease in tumor cells among rat subjects.

The oil also may help to reduce some tissue-damaging effects of radiation treatments to kill cancer cells. Black seed in combination with cysteine, vitamin E and saffron can sometimes ease side effects of the chemotherapy drug cisplatin and may potentiate the effects of other conventional chemotherapeutic drugs. These effects, however, have not been fully studied in humans.

CAUTION: Do not use black seed oil as a substitute for the conventional cancer treatments ordered by your doctor.

What about the Effect of Black Seed on Male Potency/Fertility?

From the tabloid press to traditional/alternative healers to cutting-edge science, interest abounds in possible use of black seed oil as a “cure” for male impotence and infertility. Not all claims are equally valid though.

The number of healthyspermwas increased and the anomalies significantly reduced by using Thymoquinone.

Other published research has examined the ability of black seed products to boost testosterone levels. Most of these studies have been limited to rodent subjects. In a Pakistani study where the rats’ drinking water was fortified with 5% N. sativa extract, a slight increase (19% in diabetic rats; 33% in healthy rats) in testosterone levels resulted. Another study of black seed oil at 100mg/kg administered to male wistar rats also found increased testosterone levels. The 9% improvement, however, was too little to be significant.

In contrast a small study of obese human males provided daily supplementation with 3 grams of whole black seeds for 90 days. This treatment did not increase free testosterone levels.

Verdict: The jury is still out. The antioxidant activity of black seed may be helpful to correct some male health problems. More research is necessary, though, before recommendation as a cure-all for infertility issues.

Cosmetic/Beauty Applications

Black seed oil may be useful as a beauty treatment for the skin and hair:

Hydrating hair: Black seed oil, applied to human hair, may soften it and encourage shine. Traditional healers claim that black seed oil even has the ability to help restore hair loss. Powerful antioxidant and antimicrobial properties may influence the effect. By strengthening hair follicles, black seed oil may also help strengthen hair roots.

Softening skin: Black seed oil, added to emollient lotions and moisturizers, may improve skin moisture and hydration. Known to promote and inhibit melanin production, black seed oil may benefit the skin and other cells. For example, in a recent study conducted by Iranian researchers, Nigella sativawas found as effective as the skin cream Betamethasone in improving quality of life and decreasing severity of hand eczema.

Wound healing: Application of black seed oil can diminish inflammation and decrease growth of bacteria to aid in wound healing. While it does not seem to be helpful in growing new collagen fibers, it does stimulate other growth factors to help the body create new, healthy skin. Some studies suggest that it may be a useful remedy against scars and might prevent scar formation on wounds.

CAUTION: Black seed oil should not replace skin treatments prescribed by a doctor. It might have some beauty benefits, though, that can work in addition to the physician-prescribed regimen.

Recipe and Food Uses

When eaten, the seeds have a bitter, pungent flavor somewhat like that of cumin, fennel or oregano. Whole seeds, found in many Indian and Persian markets, can be used in breads and other baked goods. They also impart flavor to some pickles. You can crush the seeds to use in beverages, teas and curries or as a pepper substitute. Black seed appears as an ingredient in the Indian herbal spice mixtures called masala and panch phoron.

Is Black Seed Oil Safe?

“Black seed, when taken by mouth in small quantities, such as a flavoring for foods, is LIKELY SAFE for most people. Black seed oil and black seed extract are POSSIBLY SAFE when medical amounts are used short-term. There isn’t enough information to know if larger, medicinal quantities are safe. Black seed can cause allergic rashes when applied to the skin.”

If you take any prescription medications regularly, talk to your doctor before starting to take black seed oil. Remember too: You should not stop taking any of your regular medications without talking to your doctor first. Pregnant or lactating women should check with a qualified healthcare professional before beginning black seed oil intake.

Black seed oil can potentiate the effects of medicines that the body processes through the cytochrome P450 pathway. Enzymes in this pathway metabolize up to 90 percent of common medications including beta-blockers such as metoprolol (Lopressor) and the blood thinner warfarin (Coumadin).

Taking too much black seed oil can potentially be harmful to your liver and kidneys. If you have problems with either of these organs, talk to your doctor to determine a safe dose (if any).

Black seed oil can develop problems if it is not extracted, processed or packaged correctly. The oil can easily turn rancid if any of these operations are substandard. Be careful, too, to store the oil inside a dark, glass bottle (preferably miron glass). Refrigeration of black seed oil can extend shelf life.

Look for the following qualities to be certain of high quality in black seed oil:

Organic

Pure-pressed/cold-pressed without chemical extraction

Contains no additives or diluting oils

Protected from rancidity by high quality light- and air-protective glass container

Alternative: Topical Pain Relievers

Along with the increasingly popular corydalis herbal remedy, pain sufferers may also use other methods for relief. Some alternatives include:

natural (complementary) methods

over-the-counter oral analgesics

hot- or cold-pack treatments

topical pain relievers

The category of topical products consists of items generally available without a doctor’s prescription. Such products include creams, lotions, gels, liquids, sprays and dermal patches to apply to the skin. They are designed to relieve localized discomfort from sore muscles and arthritis. Some examples of topical pain relievers include familiar names such as Aspercreme, Ben-Gay, Icy Hot and Capzasin.

When Is a Topical Treatment Appropriate? When Is It Not?

Why might you consider using a topical pain reliever? Some people cannot take oral medication because of difficulty with swallowing. After surgery, or for other reasons, individuals may have impaired ability to absorb drugs through the GI system. More often, though, topical remedies are appropriate when pain is localized. For example a tennis player might apply a topical agent to his shoulder for relief of discomfort in that specific area. Such products can provide short-term — but effective — relief. These treatments tend to work best on joints that are close to the surface of the skin (e.g., joints in the hands or knees).

Consumer Reports recently evaluated topical treatments under a grant from the state Attorney General Consumer and Prescriber Education Grant Program. The researchers looked at a variety of topical treatments and developed recommendations for their use.

There are three major categories of topical therapies for pain relief:

Topical Analgesics

Capsaicin is a natural, odor-free component found in hot chili peppers. It reduces pain by blocking the skin’s pain receptors. Aspirin creams work by obstructing substances in the body that cause pain in the affected area. Over-the-counter (OTC) NSAID topical products, on the other hand, work by reducing inflammation, swelling and irritation in a localized area of the body. This effect helps to decrease pressure and pain, for example, in the joints. Some specialized topical medications may even contain narcotic pain relievers. The narcotic-containing items, though, are generally dispensed by prescription only.

Local Anesthetics

These medications can numb painful areas for short periods of time. Uses vary from relieving the sting of a sunburn to managing the chronic pain of a shingles infection. Such products may also be used by a dentist to ease the pain of giving a gingival injection.

Counter-Irritants

These are products that contain substances such as menthol, eucalyptus, cinnamon or oil of wintergreen that irritate nerve endings. They produce a cool or a warm feeling on the skin which distracts the brain from registering deeper sources of pain.

Cautions

People sensitive to the active ingredient in an oral pain reliever should not try it in topical form.

Individuals who are allergic to adhesives should avoid patch-type products.

Do not use a topical pain reliever on any infected skin site.

Do not apply too much; overdose is possible, just as with oral medications.

Follow the specific directions on the product package.

Although most topical treatments are OTC products, you still need to use them properly. Follow these steps for safe, effective use:

Do not use topical products along with a heating pad because it could cause burns.

Wash your hands before and after applying.

Never touch your eyes or mucus membranes when you have topical products on your hands.

Limit your use to no more than four times per day, unless the package or your healthcare provider suggests otherwise.

Never apply to wounds or damaged skin.

Do not use any topical products under a tight bandage.

Stop using the product if it causes any irritation or if you notice that your skin is sensitive to the product.

If you are sensitive or allergic to aspirin, ask your doctor if you should avoid topical salicylates. You may also need to avoid them if you take prescription blood thinners.

Corydalis Alternative: Hot and Cold Packs

Much attention has recently focused on corydalis for relief of acute, chronic and inflammatory pain — and rightly so. Corydalis is effective, safe and easy to use. There are, however, alternative approaches to consider as well. Over-the-counter analgesic medications and topical-application products, for example, offer more ways to manage pain. So do certain alternative/complementary treatments. In addition, two simple, inexpensive and often effective methods for further pain relief are heat and cold treatments. Therapeutic icing and heating — cryotherapy and thermotherapy — are rational, cheap options for self-treatment with minimal risks. Hot or cold packs, or sometimes a combination of the two, can provide relief for sore muscles and joints.

Which Is Better for Pain Relief — Heat or Cold?

The general rule here: Ice is for injuries, and heat is for muscles. Icing is mostly just a mild, drugless way of dulling the pain of inflammation. Unfortunately ice can make muscle tension and spasms worse. Heat, on the other hand, takes the edge off pain of whole muscle spasms and trigger points while it soothes the nervous system and the mind. The downside to heat is that it can make inflammation worse. Be careful; cold and heat have the potential to do some mild harm when mixed up.

In the final analysis, though, use whichever feels better to you at the time. Your own preference is the tie-breaker and probably the most important consideration. For instance, heat cannot help if you already feel unpleasantly flushed and don’t want to be heated. And ice is unlikely to be effective if you have a chill and hate the idea of being iced. If you are trying to use one and you don’t like the feel of it, just switch to the other.

Ice packs and heating pads are not especially powerful medicine. Recent experiments have shown that both therapies have only mild benefits. Those benefits are roughly equal, for example, in treating back pain. Researchers concluded: “…choice of heat or cold therapy should be based on patient and practitioner preferences and availability.”

How Should Hot and Cold Treatments Be Used?

To get the most relief from hot or cold treatments without damaging your skin, try these tips:

use either heat or cold for only 15 to 20 minutes at a time

place a towel or clean, soft cloth between your skin and the cold or heat source

never use heat or cold on skin with open cuts or sores

do not use cold packs at all if you have poor circulation or vasculitis condition

always test the temperature before using either heat or cold

avoid creams, heat rubs or lotions on your skin while using a hot or cold treatment

use caution with heating pads because they can cause severe burns if too hot or if left on for too long

to avoid excessive fatigue and dizziness, do not make bath or shower water too hot

Cold Packs

Cold can numb sore areas and reduce inflammation by lessening blood flow to the affected area. It is especially effective to relieve swelling and pain of a joint injury or arthritis flare. Cold is best for acute pain because it restricts blood vessels, slowing circulation and reducing swelling. It also numbs nerve endings and thus dulls pain.

You can, perhaps, best apply cold by using a commercial gel cold pack. It will stay cold longer and may come in a convenient sleeve-form to wrap easily around a joint. Best of all, it won’t leak. A water bottle filled with ice and cold water can also be effective.

In a pinch you can even press common household items into service. After wrapping in a towel to protect the skin, apply any of the following items to painful areas for no more than 20 minutes at a time:

fill zip-lock plastic freezer or storage bags with ice and water

create a homemade ice pack by mixing a cup of rubbing alcohol with two cups of water and freezing in a zip-top plastic bag

apply a plastic bag filled with frozen vegetables (peas and corn are good)

dip a wash cloth or hand towel into cold water and ice; then drape it around the affected area

for an ice bath, submerge the painful area in a container filled with ice and water

Hot Packs

Heat packs relax your muscles. They enhance circulation and deliver nutrients to joints and muscles. Heat dilates blood vessels so that more oxygen and blood can flow to the area. It can also decrease the sensation of pain. Heat treatments, such as heating pads or warm baths, tend to work best for soothing stiff joints and tired muscles. Heat is also good for getting your body limber and ready for exercise or other activities.

You can apply heat with commercial heat packs, heating pads or hot water bottles. Other ways to use heat include:

soak in a warm bathtub or whirlpool

stand under a warm shower

use a warm paraffin wax treatment system for sore hand or foot joints. Such products are available for purchase at drugstores or beauty-supply stores.

apply a heating pad for up to 20 minutes at a time. Protect exposed skin with a cloth or towel buffer.

soak a washcloth or hand towel in warm water; then apply to painful joints or muscles

use moist store-bought heat pads from the drugstore. Otherwise make one by putting a wet washcloth inside a freezer bag and heating it in a microwave. Wrap the homemade hot pack in a towel and place it over the affected area for 15 to 20 minutes.

apply mineral oil to stiff, painful hand joints and put on rubber dishwashing gloves. Then place your gloved hands in hot tap water for five to ten minutes.

Alternative: Over-the-Counter Oral Analgesics

Recently corydalis herbal remedy has been receiving well-deserved attention as an excellent pain reliever. Consumers may be curious, though, about other analgesic products and pain control methods on the market today. Such treatments as oral analgesics, topical pain relievers, hot- or cold-packs and so-called “natural” methods may be helpful in certain cases.

Among over-the-counter oral analgesics there are four major categories: aspirin, acetaminophen, ibuprofen and naproxen. Each of these, with its own potency and duration of action, will bring along a specific set of benefits and drawbacks.

Aspirin

Generic term:

Major side effects:

Stomach irritant, ringing in the ears, prolonged bleeding time. Aspirin may provoke allergic reaction for individuals with salicylic acid sensitivity. It can cause stomach bleeding or worsen existing ulcers. Drinking alcohol is likely to exacerbate the situation even further. Before taking aspirin, be certain that your doctor or pharmacist knows if you are also taking any of these medications:

a blood thinner

probenecid

ticlopidine

dipyridamole

sulfinpyrazone

cortisone

Information and precautions:

Check with your health care provider before using aspirin if you are pregnant or breastfeeding. Ask for advice also if you have asthma, kidney problems, gout or a history of ulcers. Do not use aspirin if you have experienced a previous allergic reaction to it or other pain/arthritis medication. Avoid aspirin if you have an active stomach ulcer or any kind of bleeding problem.

Drink a full 8-ounce glass of water with each aspirin intake unless your doctor tells you otherwise. Do not lie down for at least ten minutes after you have taken this drug. If stomach upset occurs, you may take aspirin with food or milk.

Because of its anti-platelet effect, aspirin is sometimes recommended prophylactically to reduce the risk of heart attack or stroke.

Aspirin seems to be as effective as ibuprofen in relieving headaches and migraine pain and in reducing fevers. It may not be as helpful, though, when treating soft tissue injuries, dental pain and menstrual cramps.

alert: Never give aspirin to children or teenagers with fever, chickenpox, symptoms of the flu or viral infection. With youngsters, aspirin can cause a serious disease called Reye’s syndrome.

Acetaminophen

Brand names:

APAP, Tylenol, Panadol, paracetamol. Centrally acting analgesic and antipyretic agent with little to no anti-inflammatory property. Thought to reduce pain by acting on receptors in the brain.

Major side effects:

Hypersensitivity reactions, serious skin reactions. There is potential for liver damage especially with high-level intake or overdose, prolonged/chronic use or use along with alcohol or other liver-damaging drugs. Unlike NSAIDs, acetaminophen has no activity in the stomach. It generally does not cause problems with gastric pain or acid reflux.

Information and precautions:

Ask a doctor or pharmacist if it is safe for you to take acetaminophen if you are pregnant or breastfeeding. Consult with the healthcare team also if you have liver disease or a history of alcoholism.

Experts consider acetaminophen to be better than ibuprofen for treating headaches and arthritis. It is also less likely to cause GI irritation. In fact, of all the oral analgesics, acetaminophen is the least likely to be a stomach irritant.

alert: Taking more than 325 mg of acetaminophen at a time, taking more than one type of medication that contains acetaminophen or taking it with alcohol can lead to severe liver damage. Such consequences may eventually require a liver transplant or can even result in death.

Ibuprofen

Brand names:

Major side effects:

Severe stomach bleeding (ulcers), heartburn, GI upset and constipation. In rare cases prolonged use may lead to kidney damage, heart attack and stroke. Like other NSAIDs, ibuprofen reduces the ability of blood to clot and thus can increase bleeding after an injury. Unlike aspirin, though, its blood-thinning effect is relatively mild. If you have conditions where loss of platelets would be a concern, then ibuprofen may be the better choice. Asthma sufferers are more likely to experience allergic reactions to ibuprofen and other NSAIDs.

Information and precautions:

Avoid taking ibuprofen before and after heart surgery; do not use it if you are allergic to aspirin or any other NSAIDs. Individuals with kidney concerns should consult with a healthcare provider before taking ibuprofen. So should people with bleeding disorders, stomach ulcers, nasal polyps and liver disease. Risk is higher among people with a history of prolonged usage and those who are elderly. Also at risk are people who suffer from poor health, who smoke and/or drink regularly or who have a past diagnosis of stomach ulcer.

Because of its low levels in breast milk and its short half-life, ibuprofen may be the best choice for nursing mothers. It is routinely prescribed for infants in doses much higher than those excreted in breast milk. If you are pregnant or breastfeeding, though, always check first with your healthcare provider before taking ibuprofen or any other NSAID.

Ibuprofen appears to be slightly stronger than aspirin when treating soft tissue injuries, dental pain and menstrual cramps. It is more effective than acetaminophen for treating fevers, menstrual cramps or pain caused by inflammation (e.g., backache or dental pain). The effects of ibuprofen do not tend to last as long as do those of naproxen. Ibuprofen may need to be taken every four to six hours up to six times a day. It is better to take ibuprofen with food or milk to minimize stomach upset.

Naproxen

Brand names:

Aleve, Naprosyn — NSAID. Works by blocking an enzyme essential for synthesis of prostaglandins. These hormone-like substances cause inflammation and pain in the body.

Major side effects:

Can cause even more gastrointestinal irritation and stomach/intestinal bleeding than aspirin. It should be taken in fewer doses (no more than three times daily, every eight hours) and always with a large amount of water. Naproxen is best taken with food to minimize upset stomach. This NSAID is, however, associated with the smallest overall cardiovascular risks.

Information and Precautions:

You should not use naproxen if you have a history of allergic reaction to aspirin or other NSAIDs. Naproxen may increase your risk of heart attack or stroke, especially if you use it long term or have pre-existing heart disease. Do not use this medicine just before or after heart bypass surgery.

Ask a doctor or pharmacist if it is safe for you to take naproxen if you fall into any of these categories:

pregnant or breastfeeding

history of nasal polyps

heart, stomach, liver or kidney condition

inflammatory bowel disease

high blood pressure

asthma

abnormal bleeding condition

current or past cigarette smoker

Tell your doctor if you have ever been advised to follow a low sodium diet. Avoid drinking alcohol while taking naproxen. Do not give this medicine to a child younger than two years old without medical advice. Elderly people are more likely to have side effects; so, individuals over age 65 should take the lowest possible effective dose.

Many experts consider Naproxin to be the most powerful OTC pain reliever available without a prescription.

caution: with naproxen, avoid sunlight exposure and tanning beds because you can sunburn more easily.

How Can Diet Affect Overactive Bladder Symptoms?

Even though there is no official diet prescription, food and drink can make a big difference in overactive bladder (OAB) symptoms. What you consume, and how much you consume, can make the situation better — or much worse. Each OAB sufferer’s situation is unique, but some foods do seem to cause more problems than others. Discovering your own personal “triggers” can help you plan for your best food and beverage intake.

Beverages

OAB: What To Drink

First of all, make water your preferred beverage. Added ingredients in sodas and energy drinks, as well as the caffeine in coffee, tea and cola, may aggravate an already overactive bladder. It might be wise also to avoid certain other beverages such as pineapple, tomato or cranberry juice and carbonated drinks. Those items are known to irritate the bladder for a significant number of adults. Better substitute choices would be pure water and noncitrus juices.

OAB: When To Drink it

Staying hydrated is important to overall health. But for people with OAB, choosing wisely about how much and when to drink is absolutely essential. Remember the old saying about drinking eight 8-ounce glasses of water a day? Experts today recognize that a healthy adult actually may not need that much. The American Urogynecologic Society currently suggests, instead, drinking water when you’re thirsty.

Here are six tips for managing your fluid intake:

Spread out fluid intake throughout the day only sipping water between meals.

Unless you are exercising, don’t carry a large water bottle with you.

Fill your cup or glass half-way, or use a smaller cup instead.

Sip; don’t gulp.

If you’re drinking enough water, your urine should be light yellow or almost colorless.

Remember that you also get fluids in other foods such as fruits, vegetables and soups.

Drastically reducing your fluid intake might seem like a good way to control the urge to urinate. But drinking too little can result in more highly concentrated urine. That situation may then irritate the bladder and can thus increase the risk of a urinary tract infection.

Timing can also be crucial to coordinate fluid intake and a good night’s sleep. As part of lifestyle modifications, a schedule that limits late night drinking may be helpful.

Foods

Specific Trigger Foods

Since sensitivity to foods can vary among individuals, it is important to determine your own personal trigger foods. Once you have identified them, you can then limit your intake of whichever specific foods prompt excessive bladder activity for you. It may be helpful at first for you to keep a good food-and-symptoms diary to help pinpoint any “Bad Actors.” Depending on the food, it can take from a few minutes to several hours for symptoms to appear.

As your symptoms improve, add variety to your diet by testing out new foods, one at a time. Include fresh foods whenever possible. Processed foods are more likely to contain ingredients that can be irritating. Such substances include preservatives, artificial flavorings, additives and synthetic vitamins. Organic foods often contain fewer additives. Always read labels to detect the presence of hidden triggers. Try different brands of the same food. Various producers might include completely different ingredients or additives that could irritate the bladder.

Avoid foods that you know you are allergic to even if you otherwise find them listed on a “safe” list for OAB sufferers. Pre-existing food allergies might also trigger bladder irritation and/or a stronger allergic reaction. Examples include sensitivity to certain nuts, eggs, grains and shellfish.

General Categories for Caution

Some foods or categories of food are known to cause problems for many OAB sufferers. Although there may be variability among individuals, these items seem to cause disproportionate consequences. Eliminating or limiting their intake often can improve OAB symptoms.

For example, avoiding prunes, citrus and pineapple- or tomato-based foods may be advisable. Those items are known to irritate the bladder for a significant number of adults. Better choices could be noncitrus fruits such as peaches, blueberries, melons, pears and coconut. Instead of onions, try substituting shallots. Cooking with extracts and mild herbs instead of pungent spices and fiery condiments might also help to manage OAB symptoms. Avoid hot pepper sauce, vinegar, wasabi, MSG, mustard, mayonnaise and soy sauce. Substituting imitation sour cream and processed, non-aged cheese for creamy, rich sour cream and sharp/zesty, aged cheese can minimize symptoms.

It is advisable, too, to limit the total intake of processed foods. Read package labels carefully to discover artificial flavors and hidden preservatives or additives. Go “fresh and all-natural” whenever possible to optimize the nutrients, vitamins and minerals in food as well.

You can visit online sites to find detailed food lists that group together “generally safe” and “potentially dangerous” foods for OAB sufferers. Remember, though, such lists are general in nature and need to be fine-tuned and individualized for your particular situation.

Sugar and Sweeteners

Use as little as possible of added sugars, artificial sweeteners and even honey. Such items often cause an increase in symptoms. Sugar may encourage bacterial growth too. Bacteria can cause urinary tract and bladder infections, which in turn may intensify OAB symptoms.

Salty Foods

Take the salt shaker off your dining table. If you do think about adding salt from the shaker, always taste the food first to be sure you really need it. Then shake only the bare minimum. Limit or eliminate salt in cooking/preparation. Avoid cured and processed meats, pickled foods and salty sauces. Reduce consumption of salty snack foods like potato chips, salted nuts and other high-sodium nibbles. These items can cause the body to retain too much water. Eventually it all has to go to the bladder for elimination. Salty items also often increase thirst and therefore lead an individual to drink an excessive amount of liquids. An effective solution might be to switch to low- or no-salt replacement snacks such as veggies and fruit or unsalted popcorn.

Milk and Dairy Products

Some people with an overactive bladder may find that milk and dairy products make their symptoms worse. This caution doesn’t mean that everyone with bladder problems will necessarily have a bad reaction to dairy. If you keep a careful food intake diary, you can use that record to figure out which foods do bother you. Then you will be able to minimize or eliminate those items from your own daily diet.

High-Fiber Foods

Consuming the right amount of dietary fiber can ward off constipation. This condition is not only uncomfortable in itself but also can increase the likelihood of both OAB and incontinence symptoms. Because the bladder and the bowel are so close to each other, constipation puts pressure on the bladder. Severe constipation (less than one elimination weekly) can even damage the neurological function of pelvic floor muscles. Such injury could make it much more difficult to get bladder symptoms under control.

Fortunately research has shown the reverse to be true as well. Alleviating constipation may significantly improve control of urinary frequency and urgency. To maximize the effect of fiber intake, combine both soluble fiber and insoluble fiber. One absorbs water and slows digestion; the other helps maintain regularity on a daily basis.

Good sources of fiber include:

whole-grain breads and cereals

barley

brown rice

oatmeal

beans or peas

fresh or dried fruit

raw vegetables

unsalted popcorn

whole-grain crackers

a handful of unsalted nuts

Caffeine-Containing Foods

Limit caffeine intake from beverages like coffee and tea. Experiment instead with substituting herbal teas for “regular“ or even decaffeinated coffee or tea. Be cautious with drinking energy drinks and some sodas such as cola and a few other flavors. As always, read each label carefully. To lessen the feeling of urgency to urinate, reduce your consumption of chocolate candy, some mints and chewing gum as well as hot or cold beverages, ice cream, frozen yogurt, puddings and other desserts if they are flavored with coffee and/or chocolate.

Beware also of some over-the-counter diet pills, stimulants, pain relievers and cold/allergy medications which contain high amounts of caffeine. In fact you should read all product labels carefully to identify unexpected caffeine sources. Surprisingly, some brands of beef jerky, instant oatmeal and even “energized” sunflower seeds can include significant caffeine too.

Alcohol

Avoid excessive alcohol intake. If you drink alcoholic beverages at all, consume no more than a single glass of wine or liquor per day. Carbonated or “fizzy,” “bubbly” drinks may be more risky than others.

note: it may be especially helpful in managing OAB to minimize or eliminate beer consumption.

Meal Planning

Advance planning can make food management easier. Consulting with a registered dietitian or licensed nutritionist may help you improve food selections. For self-help, the website www.MyPyramid.gov offers advice on meal planning.

To begin, plan your food intake to include all meals and snacks for the entire day. At the start it may be easier if you keep meals as simple as possible. It is much quicker to sort out which foods are causing your symptoms to flare if you are eating simple dishes with few ingredients.

Include family members in your planning process. If there are other individuals who regularly eat at your home, ask for their aid. When the people in your household help with menu choices, it will increase their understanding of your condition. Be willing to include some foods in the plan for them even if those choices might be trigger foods for you. Then serve those “special requests” to the other folks at your table, but avoid eating them yourself.

Finally group together all the days in an entire week, and then write your shopping list. Sticking to a grocery list will help you resist impulse buying, which can be tough on both the wallet and the bladder. Once you have developed a few weeks of menus that you and your family enjoy, go ahead and reuse them. To simplify planning, recycle your grocery lists, too. You do not have to re-invent the wheel each time!

A Final Thought

Remember: eating healthy and avoiding foods that can trigger bladder symptoms is something you can control. It gets easier with practice as time goes on. Take the first step today to make changes that will improve your quality of life.

Sjögren’s Syndrome — Treatment

There is no cure yet for Sjögren’s syndrome. As is typical with other autoimmune diseases, the severity of Sjögren’s can vary from person to person. Many patients experience a mild disease that affects not only the eyes but also the mouth. Over time, though, other individuals may develop additional symptoms of variable severity. Alternatively, for other people, the condition may improve and sometimes even go into remission. Unfortunately a few Sjögren’s sufferers eventually exhibit severe and chronic (long-term) symptoms.

Current treatments focus on managing the symptoms. Moisture replacement therapies, for example, help to relieve dryness. Similarly nonsteroidal anti-inflammatory drugs (NSAIDs) can sometimes control inflammation. People with severe Sjögren’s syndrome may receive corticosteroids, which mimic hormones that fight inflammation in the body, or disease-modifying antirheumatic drugs (DMARDs), which suppress the body’s overextended immune response.

An experienced healthcare team can determine the best combination of over-the-counter treatments, prescription medications and medical procedures for any individual situation. Some Sjögren’s patients have found additional relief using environmental modifications together with holistic/herbal approaches such as diet management, exercise, progressive relaxation, Traditional Chinese Medicine, acupuncture and other mind-body techniques.

While it is true that Sjögren’s syndrome can affect the entire body, a Sjögren’s sufferer should not automatically assume that Sjögren’s is the cause every time a different symptom pops up. The best course of action with a new or significant physical change is to consult with the medical caregiver. Usually a physician or other qualified professional can help determine the actual cause of any troublesome symptoms. Then the healthcare team can go to work and find the best treatment for each of them.

Sjögren’s Syndrome — Research and Clinical Trials

Research is currently underway searching in various directions for new medications, therapies and diagnostic tools to improve treatment of Sjögren’s syndrome. Recommendation: in summary, use this information in conjunction with advice from your health care professionals.

Additional Sources for Clinical Trial Information

Below are links that may help you find appropriate clinical trials in your local area:

ClinicalTrials.gov is a registry of federally and privately supported clinical trials conducted in the United States and around the world. Here you will find information about the objective of each trial, requirements for participation, locations and contact information for more details. http://www.clinicaltrials.gov

CenterWatch.com includes a Clinical Trial Listing Service, which provides unbiased information on clinical trials with a database that contains thousands of currently-enrolling studies. Information on drugs and new medical therapies is also available to review here along with health and educational resources. http://www.centerwatch.com

Ora is the largest independent eye research and development firm in the world. It is currently working with multiple global pharmaceutical companies to find better dry eye treatments. http://www.eyedrop.com/study_participants/upcoming_studies/template.aspx?ekfrm=134

More Information Sources

For additional up-to-date Sjögren’s syndrome information, the following sites may be helpful:

The official U. S. government information website about Sjögren’s syndrome and its treatment can be accessed from the National Institutes of Health. http://www.niams.nih.gov/health_info

Founded in 1983, the Sjögren’s Syndrome Foundation provides patients with practical information and coping strategies. In addition the Foundation also serves as a clearinghouse for medical information and advocates on the national level for Sjögren’s sufferers. https://www.sjogrens.org/